Aesthetic Applications of Brava-Assisted Megavolume Fat Grafting to the Breasts: A 9-Year, 476-Patient, Multicenter Experience

Background: Autologous fat grafting to the breasts was banned in 1987 because of unpredictable graft retention and cyst formation that could not be differentiated from cancer. Surgical and radiologic advances induced a lifting of the ban in 2009. Small- to moderate-volume autologous fat grafting to the breast has become common. The authors present their aesthetic applications of megavolume autologous fat grafting to the breast. Methods: Autologous fat grafting with Brava preexpansion was performed on 294 patients for aesthetic augmentation, 45 patients for congenital deformity correction, 43 patients for iatrogenic deformity correction, and six patients for implant-to-fat conversion. Autologous fat grafting for implant-to-fat conversion was performed on 88 patients without Brava. A case example is presented for each indication. The baseline, perioperative, grafted, and postoperative volumes were recorded. Results: Follow-up ranges from 6 months to 9 years (mean, 3.5 years). The mean volume grafted was 346 ml per breast, and the mean postoperative augmentation measured at least 6 months postoperatively was 266 ml per breast. No patients required open biopsy or were diagnosed with cancer. There was one pneumothorax, requiring a temporary chest tube, with no further complication. Conclusion: Large-volume autologous fat grafting after Brava use or implant removal is a safe and effective alternative for breast augmentation and deformity correction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.